Reducing Hypertension among African American Men: A Mobile Stress Management Intervention to Address Health Disparities

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PROJECT SUMMARY/ABSTRACT African American men have the highest rate of hypertension (HTN) in the United States. Once diagnosed, they are also less likely than other groups to achieve blood pressure (BP) control. This health disparity is critical, as elevated BP is the primary modifiable risk factor for cardiovascular disease. One reason for this HTN disparity: stress. African Americans experience more stress than their White peers, most notably from racial discrimination, and have fewer resources to manage these stressors. This stress has significant physiological consequences. Compared to Whites, African Americans show heightened allostatic load, a measure of the biological effects of chronically activating the stress physiological systems. Importantly, stress-induced activation of these systems is implicated in the etiology of HTN. Stress also exacerbates HTN through unhealthy coping (e.g., smoking, overeating, alcohol use) and poorer adherence to antihypertensive medications. Stress predicts these coping behaviors and medical noncompliance in African Americans. Despite clear links between stress and HTN, stress management is not regularly deployed to manage BP. This is a missed opportunity because stress management interventions have been shown to improve HTN. Existing research on stress management interventions for BP reduction included mostly White participants. This is significant because behavioral health programs designed specifically for minority groups are more effective than generic programs. Because stress significantly drives health disparities in HTN, developing effective stress management programs for African American men is vital to closing this gap. One cost-effective, easily scalable solution is mHealth. One of the most accessible mobile formats is text messaging. Importantly, 98% of African Americans own a mobile phone. Most are smartphones (70%). To our knowledge, no mobile cognitive behavioral stress management intervention has been developed for African American men to manage racial and nonracial sources of stress in an effort to reduce HTN disparities. We intend to fill this void. When completed, educational text messages will increase knowledge, develop skills, and reduce barriers to adaptive coping. Supportive texts will affirm the life experiences of African American men. A library of individually tailored videos will be delivered to each user depending on a theory-based assessment of stress (including perceived discrimination) and coping. All mobile web content will be effortlessly and efficiently accessed via touch-based links embedded within text messages. Eighteen African American men will be recruited for focus group discussions to inform prototype development. When the prototype is completed, these 18 target end-users will return for usability testing. The usability test will include a series of tasks intended to highlight the different features of the proposed intervention. Three usability metrics will be assessed: efficiency, accuracy, and acceptability.